Bill Text: NY A06027 | 2023-2024 | General Assembly | Amended

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Bill Title: Relates to regulation of the billing by general hospitals and the distribution of funds from the general hospital indigent care pool; requires use of a uniform application form and policy.

Spectrum: Partisan Bill (Democrat 46-1)

Status: (Introduced - Dead) 2024-01-03 - referred to health [A06027 Detail]

Download: New_York-2023-A06027-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         6027--A

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                     March 30, 2023
                                       ___________

        Introduced  by M. of A. PAULIN, SEAWRIGHT, REYES, RAMOS, SIMON, EPSTEIN,
          BICHOTTE HERMELYN, STECK, MITAYNES, McDONOUGH, L. ROSENTHAL,  BENEDET-
          TO,  FORREST,  BURGOS,  GONZALEZ-ROJAS, RIVERA, GIBBS, KELLES, THIELE,
          ZINERMAN, DE LOS SANTOS, JACKSON, JEAN-PIERRE, HYNDMAN, RAGA,  ARDILA,
          LEVENBERG,  SEPTIMO,  AUBRY, HEVESI, MAMDANI, McDONALD, SIMONE, SHRES-
          THA, GLICK, ZACCARO, COLTON, STIRPE, DINOWITZ, CUNNINGHAM -- read once
          and referred to the Committee on Health -- committee discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee

        AN ACT to amend the public health law, in relation to the general hospi-
          tal indigent care pool; and to repeal certain provisions of  such  law
          relating thereto

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subdivision 9 of section 2807-k of the public  health  law,
     2  as amended by section 17 of part B of chapter 60 of the laws of 2014, is
     3  amended to read as follows:
     4    9.  In order for a general hospital to participate in the distribution
     5  of funds from the pool, the general  hospital  must  [implement  minimum
     6  collection  policies  and  procedures  approved]  utilize only a uniform
     7  financial assistance policy and  form  developed  and  provided  by  the
     8  [commissioner] department. All general hospitals that do not participate
     9  in  the indigent care pool shall also utilize only the uniform financial
    10  assistance policy and form and otherwise comply with subdivision  nine-a
    11  of  this  section  governing  the  provision of financial assistance and
    12  hospital collection procedures.
    13    § 1-a. Subdivision 9 of section 2807-k of the public  health  law,  as
    14  amended by section 1 of subpart C of part Y of chapter 57 of the laws of
    15  2023, is amended to read as follows:
    16    9.  In order for a general hospital to participate in the distribution
    17  of funds from the pool, the general  hospital  must  [implement  minimum

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02400-02-3
        A. 6027--A                          2

     1  collection policies and procedures approved by the commissioner, utiliz-
     2  ing]  utilize only a uniform financial assistance policy and form devel-
     3  oped and provided by the department. All general hospitals that  do  not
     4  participate  in  the  indigent  care  pool  shall  also utilize only the
     5  uniform financial assistance policy and form and otherwise  comply  with
     6  subdivision  nine-a of this section governing the provision of financial
     7  assistance and hospital collection procedures.
     8    § 2.  Subdivision 9-a of section 2807-k of the public health  law,  as
     9  added by section 39-a of part A of chapter 57 of the laws of 2006, para-
    10  graph  (k) as added by section 43 of part B of chapter 58 of the laws of
    11  2008, is amended to read as follows:
    12    9-a. (a) (i) As a condition for participation  in  pool  distributions
    13  authorized  pursuant  to  this  section and section twenty-eight hundred
    14  seven-w of this article for periods on  and  after  January  first,  two
    15  thousand  nine,  general  hospitals  shall, effective for periods on and
    16  after January first,  two  thousand  seven,  establish  financial  [aid]
    17  assistance policies and procedures, in accordance with the provisions of
    18  this  subdivision, for reducing hospital charges otherwise applicable to
    19  low-income individuals [without health insurance, or who have  exhausted
    20  their  health  insurance benefits, and] who can demonstrate an inability
    21  to pay full charges, and also, at the hospital's discretion, for  reduc-
    22  ing  or  discounting  the  collection of co-pays and deductible payments
    23  from those individuals who can demonstrate  an  inability  to  pay  such
    24  amounts.  Immigration  status  shall not be an eligibility criterion for
    25  the purpose of determining financial assistance under this section.
    26    (ii) A general hospital may use the New York state of  health  market-
    27  place  eligibility  determination page to establish the patient's house-
    28  hold income and residency in lieu of  the  financial  application  form,
    29  provided  it  has secured the consent of the patient. A general hospital
    30  shall not require a patient to apply for coverage through the  New  York
    31  state  of  health  marketplace  in  order  to  receive care or financial
    32  assistance.
    33    (iii) Upon submission of a completed application form, the patient  is
    34  not  liable  for  any bills and no interest may accrue until the general
    35  hospital has rendered a decision on the application in  accordance  with
    36  this subdivision.
    37    (b)  [Such]  The  reductions  from  charges  for  [uninsured] patients
    38  described in paragraph (a) of this subdivision with  incomes  below  [at
    39  least  three]  six  hundred  percent  of the federal poverty level shall
    40  result in a charge to such individuals that does not exceed [the greater
    41  of] the amount that would have been paid for the same services  [by  the
    42  "highest  volume payor" for such general hospital as defined in subpara-
    43  graph (v) of this paragraph, or for services provided pursuant to  title
    44  XVIII  of  the  federal social security act (medicare), or for services]
    45  provided pursuant to title [XIX] XVIII of the  federal  social  security
    46  act (medicaid), and provided further that such [amounts] amount shall be
    47  adjusted according to income level as follows:
    48    (i)  For  patients with incomes at or below [at least one] two hundred
    49  percent of the federal poverty level, the  hospital  shall  [collect  no
    50  more  than  a  nominal payment amount, consistent with guidelines estab-
    51  lished by the commissioner] waive all charges. No nominal payment  shall
    52  be collected;
    53    (ii)  For  patients  with  incomes  [between  at  least one] above two
    54  hundred [one] percent and [one] up to four hundred  [fifty]  percent  of
    55  the  federal  poverty level, the hospital shall collect no more than the
    56  amount identified after application of a proportional sliding fee sched-
        A. 6027--A                          3

     1  ule under which patients with lower incomes shall pay the lowest amount.
     2  [Such] The schedule shall provide  that  the  amount  the  hospital  may
     3  collect  for  [such  patients]  the  patient  increases from the nominal
     4  amount  described  in subparagraph (i) of this paragraph in equal incre-
     5  ments as the income of the patient increases, up to a maximum of  twenty
     6  percent of the [greater of the] amount that would have been paid for the
     7  same  services [by the "highest volume payor" for such general hospital,
     8  as defined in subparagraph  (v)  of  this  paragraph,  or  for  services
     9  provided  pursuant  to  title  XVIII  of the federal social security act
    10  (medicare) or for services] provided pursuant to title  [XIX]  XVIII  of
    11  the federal social security act (medicaid);
    12    (iii)  [For  patients with incomes between at least one hundred fifty-
    13  one percent and two hundred fifty percent of the federal poverty  level,
    14  the  hospital  shall  collect  no  more than the amount identified after
    15  application of a proportional sliding fee schedule under which  patients
    16  with  lower  income  shall  pay  the lowest amounts. Such schedule shall
    17  provide that the amount the  hospital  may  collect  for  such  patients
    18  increases  from the twenty percent figure described in subparagraph (ii)
    19  of this paragraph in equal increments  as  the  income  of  the  patient
    20  increases,  up to a maximum of the greater of the amount that would have
    21  been paid for the same services by the "highest volume payor"  for  such
    22  general  hospital,  as defined in subparagraph (v) of this paragraph, or
    23  for services provided pursuant to title  XVIII  of  the  federal  social
    24  security  act  (medicare) or for services provided pursuant to title XIX
    25  of the federal social security act (medicaid); and
    26    (iv)] For patients with incomes [between at least two  hundred  fifty-
    27  one  percent and three hundred] above four hundred percent and up to six
    28  hundred percent of the federal poverty level, the hospital shall collect
    29  no more than the [greater of the] amount that would have been  paid  for
    30  the same services [by the "highest volume payor" for such general hospi-
    31  tal  as  defined  in subparagraph (v) of this paragraph, or for services
    32  provided pursuant to title XVIII of  the  federal  social  security  act
    33  (medicare),  or  for services] provided pursuant to title [XIX] XVIII of
    34  the federal social security act (medicaid).
    35    [(v) For the purposes of this paragraph, "highest volume payor"  shall
    36  mean  the  insurer,  corporation  or organization licensed, organized or
    37  certified pursuant to article thirty-two, forty-two  or  forty-three  of
    38  the insurance law or article forty-four of this chapter, or other third-
    39  party  payor,  which  has  a  contract  or  agreement  to pay claims for
    40  services provided by the  general  hospital  and  incurred  the  highest
    41  volume of claims in the previous calendar year.
    42    (vi)  A  hospital may implement policies and procedures to permit, but
    43  not require, consideration on a case-by-case basis of exceptions to  the
    44  requirements  described  in subparagraphs (i) and (ii) of this paragraph
    45  based upon the existence of significant assets owned by the patient that
    46  should be taken into account  in  determining  the  appropriate  payment
    47  amount  for  that  patient's care, provided, however, that such proposed
    48  policies and procedures  shall  be  subject  to  the  prior  review  and
    49  approval  of the commissioner and, if approved, shall be included in the
    50  hospital's financial assistance  policy  established  pursuant  to  this
    51  section,  and  provided  further  that, if such approval is granted, the
    52  maximum amount that may be collected shall not exceed the greater of the
    53  amount that would have been paid for the same services by  the  "highest
    54  volume  payor"  for such general hospital as defined in subparagraph (v)
    55  of this paragraph, or for services provided pursuant to title  XVIII  of
    56  the  federal  social  security  act (medicare), or for services provided
        A. 6027--A                          4

     1  pursuant to title XIX of the federal social security act (medicaid).  In
     2  the  event  that a general hospital reviews a patient's assets in deter-
     3  mining payment  adjustments  such  policies  and  procedures  shall  not
     4  consider  as assets a patient's primary residence, assets held in a tax-
     5  deferred or  comparable  retirement  savings  account,  college  savings
     6  accounts,  or  cars  used  regularly  by  a  patient or immediate family
     7  members.
     8    (vii)] (c) Nothing in this [paragraph] subdivision shall be  construed
     9  to  limit  a  hospital's  ability  to  establish patient eligibility for
    10  payment discounts at income levels higher than  those  specified  herein
    11  and/or  to  provide greater payment discounts for eligible patients than
    12  those required by this [paragraph] subdivision.
    13    [(c)] (d) Such policies and procedures shall be clear, understandable,
    14  in writing and publicly available in summary  form  [and  each].    Each
    15  general  hospital  participating  in  the  pool  shall ensure that every
    16  patient is made aware of the existence of [such] the policies and proce-
    17  dures and is provided, in a timely manner, with a summary and a copy  of
    18  [such  policies  and  procedures  upon  request]  the policy and form at
    19  intake, admission and discharge.    Any  summary  provided  to  patients
    20  shall, at a minimum, include, in plain language, specific information as
    21  to  income  levels  used  to  determine  eligibility  for assistance, [a
    22  description of the primary  service  area  of  the  hospital]  financial
    23  assistance  available  and  the  means  of applying for assistance. [For
    24  general hospitals with  twenty-four  hour  emergency  departments,  such
    25  policies  and  procedures]  A  plain language summary of the collections
    26  process must also be made available. A general hospital  shall  [require
    27  the notification of patients] notify patients by providing written mate-
    28  rials  to patients or their authorized representatives during the intake
    29  and registration process, by making materials available  in  conspicuous
    30  locations in the hospital including emergency departments, waiting areas
    31  and other places patients congregate, through the conspicuous posting of
    32  language-appropriate information in the general hospital, and by includ-
    33  ing information on bills and statements sent to patients, that financial
    34  [aid]  assistance  may  be  available  to  qualified patients and how to
    35  obtain further information. [For specialty hospitals without twenty-four
    36  hour emergency departments, such notification shall take  place  through
    37  written  materials  provided to patients during the intake and registra-
    38  tion process prior to the provision  of  any  health  care  services  or
    39  procedures,  and  through  information  on  bills and statements sent to
    40  patients, that financial aid may be available to qualified patients  and
    41  how to obtain further information. Application materials shall include a
    42  notice  to  patients  that  upon  submission of a completed application,
    43  including any information  or  documentation  needed  to  determine  the
    44  patient's  eligibility  pursuant  to the hospital's financial assistance
    45  policy, the patient may disregard  any  bills  until  the  hospital  has
    46  rendered  a  decision  on  the application in accordance with this para-
    47  graph] General hospitals shall post the financial assistance application
    48  policy, procedures and form, and a summary of the policy and  procedures
    49  and  collection process, in a conspicuous location and downloadable form
    50  on the general hospital's website.
    51    [(d) Such] (e) The hospital's application materials  shall  include  a
    52  notice to patients that upon submission of a completed application form,
    53  the patient shall not be liable for any bills until the general hospital
    54  has  rendered  a  decision  on  the  application in accordance with this
    55  subdivision.  The application materials shall include specific  informa-
    56  tion  as  the  income levels used to determine eligibility for financial
        A. 6027--A                          5

     1  assistance, a description of the primary service area  of  the  hospital
     2  and the means to apply for assistance. Nothing in this subdivision shall
     3  be  construed  as precluding the use of presumptive eligibility determi-
     4  nations  by hospitals on behalf of patients. The policies and procedures
     5  shall include clear, objective  criteria  for  determining  a  patient's
     6  ability  to  pay  and for providing such adjustments to payment require-
     7  ments as are necessary. In addition to  adjustment  mechanisms  such  as
     8  sliding  fee  schedules  and discounts to fixed standards, such policies
     9  and procedures shall also provide for the use of installment  plans  for
    10  the  payment  of  outstanding  balances  by  patients  pursuant  to  the
    11  provisions of the hospital's financial assistance  policy.  The  monthly
    12  payment  under  such  a  plan shall not exceed [ten] five percent of the
    13  gross monthly income of the patient[, provided, however, that if patient
    14  assets are considered under such a policy, then patient assets which are
    15  not excluded assets pursuant to subparagraph (vi) of  paragraph  (b)  of
    16  this  subdivision  may be considered in addition to the limit on monthly
    17  payments]. Installment plan payments may not be required to begin before
    18  one hundred eighty days after the date  of  the  service  or  discharge,
    19  whichever  is later. The policy shall allow the patient and the hospital
    20  to mutually agree to modify the terms of an installment plan.  The  rate
    21  of  interest charged to the patient on the unpaid balance, if any, shall
    22  not exceed [the rate for a ninety-day  security  issued  by  the  United
    23  States  Department of Treasury, plus .5 percent] two percentum per annum
    24  and no plan shall include an accelerator or similar clause under which a
    25  higher rate of interest is triggered upon a missed payment.   [If  such]
    26  The policies and procedures shall not include a requirement of a deposit
    27  prior to [non-emergent,] medically-necessary care[, such deposit must be
    28  included  as  part  of  any financial aid consideration].   The hospital
    29  shall refund any payments made by the patient before  the  determination
    30  of  eligibility  for  financial  assistance  that  exceeds the patient's
    31  liability after discounts are  applied.  Such  policies  and  procedures
    32  shall be applied consistently to all eligible patients.
    33    [(e) Such policies and procedures shall permit patients to] (f) In any
    34  legal  action  by  or on behalf of a hospital to collect a medical debt,
    35  the complaint shall be accompanied by an  affidavit  by  the  hospital's
    36  chief  financial  officer stating that the hospital has taken reasonable
    37  steps to determine whether the patient qualifies for  financial  assist-
    38  ance  and  upon  information  and  belief  the patient does not meet the
    39  income or residency criteria  for  financial  assistance.  Patients  may
    40  apply  for financial assistance [within at least ninety days of the date
    41  of discharge or date of service and provide at  least  twenty  days  for
    42  patients  to  submit  a  completed  application]  at any time during the
    43  collection process, including after the commencement of a  medical  debt
    44  court  action  or  upon  the  plaintiff obtaining a default judgment.  A
    45  determination that a patient is eligible for financial assistance  shall
    46  be  valid for a minimum of twelve months and will apply to all outstand-
    47  ing medical bills. A hospital may use credit scoring  software  for  the
    48  purposes  of  establishing  income  eligibility  and approving financial
    49  assistance, but only if the hospital makes clear  to  the  patient  that
    50  providing a social security number is not mandatory and the scoring does
    51  not negatively impact the patient's credit score.  However, credit scor-
    52  ing  software shall not be solely relied upon by the hospital in denying
    53  a patient's application for financial assistance. Further, propensity to
    54  pay scores may not disqualify patients who otherwise qualify for  eligi-
    55  bility  from  receiving  financial  assistance.  [Such] The policies and
    56  procedures [may require that]  shall  allow  patients  seeking  [payment
        A. 6027--A                          6

     1  adjustments] financial assistance to provide [appropriate] the following
     2  financial  information  and  documentation  in support of their applica-
     3  tion[, provided, however, that such application  process  shall  not  be
     4  unduly  burdensome  or  complex]:  pay checks or pay stubs; unemployment
     5  documentation; social security income; rent receipts; a letter from  the
     6  patient's  employer  attesting to the patient's gross income; documenta-
     7  tion of eligibility for other means-tested government benefits;  or,  if
     8  none  of the aforementioned information and documentation are available,
     9  a written self-attestation of the patient's income may be used.  General
    10  hospitals  [shall,  upon  request,] must take reasonable steps to assist
    11  patients in understanding the hospital's application and form,  policies
    12  and  procedures  and  in  applying  for payment adjustments. Application
    13  forms shall be printed  and  posted  to  its  website  in  the  "primary
    14  languages"  of patients served by the general hospital. For the purposes
    15  of this paragraph, "primary languages" shall include any  language  that
    16  is  either  (i)  used  to  communicate,  during at least five percent of
    17  patient visits in a year, by patients who cannot speak, read,  write  or
    18  understand  the  English  language at the level of proficiency necessary
    19  for effective communication with health care providers, or  (ii)  spoken
    20  by  [non-English]  limited-English  speaking individuals comprising more
    21  than one percent of the primary hospital  service  area  population,  as
    22  calculated  using  demographic  information  available  from  the United
    23  States Bureau of the Census, supplemented by data from  school  systems.
    24  Decisions  regarding  such applications shall be made within thirty days
    25  of receipt of a completed application. [Such] The  policies  and  proce-
    26  dures shall require that the hospital issue any [denial/approval] denial
    27  or  approval of [such] the application in writing which clearly communi-
    28  cates the amount of assistance granted,  any  amounts  still  owed  with
    29  information on how to appeal the [denial] decision and shall require the
    30  hospital  to  establish  an appeals process under which it will evaluate
    31  the [denial of] decision about an application. [Nothing in this subdivi-
    32  sion shall be interpreted as prohibiting  a  hospital  from  making  the
    33  availability  of  financial assistance contingent upon the patient first
    34  applying for coverage under title XIX of the social security act  (medi-
    35  caid)  or another insurance program if, in the judgment of the hospital,
    36  the patient may be eligible for medicaid or another  insurance  program,
    37  and upon the patient's cooperation in following the hospital's financial
    38  assistance application requirements, including the provision of informa-
    39  tion  needed  to  make  a  determination on the patient's application in
    40  accordance with the hospital's financial assistance policy]  Nothing  in
    41  this subdivision shall prevent a hospital from informing and assisting a
    42  patient  with  an application for health insurance coverage with a local
    43  services district or the marketplace. A  hospital  shall  not  make  the
    44  availability  of  financial  assistance  contingent  upon  the patient's
    45  application for health insurance coverage.   The hospital  shall  inform
    46  patients  on  how  to  file  a  complaint against the hospital or a debt
    47  collector that is contracted on behalf of  the  hospital  regarding  the
    48  patient's bill.  General hospitals are required to take reasonable meas-
    49  ures  to  determine if a patient  is  eligible  for financial assistance
    50  including prior to making a referral to a third-party debt collector  or
    51  other extraordinary collections measures.
    52    [(f) Such] (g) The policies and procedures shall provide that patients
    53  with  incomes  below  [three] six hundred percent of the federal poverty
    54  level are deemed [presumptively] eligible for  payment  adjustments  and
    55  shall  conform  to  the  requirements set forth in paragraph (b) of this
    56  subdivision, provided, however, that nothing in this  subdivision  shall
        A. 6027--A                          7

     1  be  interpreted  as  precluding  hospitals  from  extending such payment
     2  adjustments to other patients, either generally  or  on  a  case-by-case
     3  basis.  [Such  policies  and  procedures shall provide financial aid for
     4  emergency  hospital  services, including emergency transfers pursuant to
     5  the federal emergency medical treatment and active  labor  act  (42  USC
     6  1395dd),  to  patients  who  reside  in New York state and for medically
     7  necessary hospital services for patients who reside  in  the  hospital's
     8  primary  service area as determined according to criteria established by
     9  the commissioner. In developing such criteria,  the  commissioner  shall
    10  consult  with  representatives  of  the  hospital  industry, health care
    11  consumer advocates and local  public  health  officials.  Such  criteria
    12  shall  be made available to the public no less than thirty days prior to
    13  the date of implementation and shall, at a minimum:
    14    (i) prohibit a  hospital  from  developing  or  altering  its  primary
    15  service  area in a manner designed to avoid medically underserved commu-
    16  nities or communities with high percentages of uninsured residents;
    17    (ii) ensure that every geographic area of the state is included in  at
    18  least  one  general  hospital's  primary  service  area so that eligible
    19  patients may access care and financial assistance; and
    20    (iii) require the hospital to notify the commissioner upon making  any
    21  change  to its primary service area, and to include a description of its
    22  primary service area in  the  hospital's  annual  implementation  report
    23  filed  pursuant  to  subdivision  three  of section twenty-eight hundred
    24  three-l of this article.
    25    (g) Nothing in this subdivision shall  be  interpreted  as  precluding
    26  hospitals  from  extending  payment  adjustments for medically necessary
    27  non-emergency hospital services to patients outside  of  the  hospital's
    28  primary service area.] For patients determined to be eligible for finan-
    29  cial  [aid]  assistance  under the terms of a hospital's financial [aid]
    30  assistance policy, [such] the policies and procedures shall prohibit any
    31  limitations on financial [aid] assistance  for  services  based  on  the
    32  medical  condition  of  the applicant, other than typical limitations or
    33  exclusions based on medical necessity or  the  clinical  or  therapeutic
    34  benefit of a procedure or treatment.
    35    (h)  [Such  policies  and  procedures  shall  not permit the forced] A
    36  hospital or its agent shall not issue, authorize  or  permit  an  income
    37  execution  of  a patient's wages, secure a lien or force a sale or fore-
    38  closure of  a  patient's  primary  residence  in  order  to  collect  an
    39  outstanding medical bill and shall [require the hospital to refrain from
    40  sending]  not send an account to collection if the patient has submitted
    41  a completed application  for  financial  [aid,  including  any  required
    42  supporting  documentation] assistance, while the hospital determines the
    43  patient's eligibility for [such aid] financial assistance.   [Such]  The
    44  policies  and  procedures  shall provide for written notification, which
    45  shall include notification on a patient bill, to a patient not less than
    46  thirty days prior to the referral of  debts  for  collection  and  shall
    47  require that the collection agency obtain the hospital's written consent
    48  prior  to  commencing a legal action. [Such] The policies and procedures
    49  shall require all general hospital staff who interact with  patients  or
    50  have  responsibility for billing and collections to be trained in [such]
    51  the policies and procedures, and require the implementation of  a  mech-
    52  anism for the general hospital to measure its compliance with [such] the
    53  policies  and  procedures.    [Such]  The  policies and procedures shall
    54  require that any collection agency, lawyer or firm under contract with a
    55  general hospital for the  collection  of  debts  follow  the  hospital's
    56  financial assistance policy, including providing information to patients
        A. 6027--A                          8

     1  on  how  to apply for financial assistance where appropriate. [Such] The
     2  policies and procedures shall prohibit collections from a patient who is
     3  determined to be eligible for medical assistance [pursuant to title  XIX
     4  of  the  federal social security act] under title eleven of article five
     5  of the social services law at the time services were  rendered  and  for
     6  which services medicaid payment is available.
     7    (i) Reports required to be submitted to the department by each general
     8  hospital  as  a  condition  for  participation  in the pools[, and which
     9  contain, in accordance with applicable regulations,] shall contain:  (i)
    10  a certification from an independent certified public accountant or inde-
    11  pendent licensed public accountant or an attestation from a senior offi-
    12  cial  of the hospital that the hospital is in compliance with conditions
    13  of participation in the pools[, shall also contain, for reporting  peri-
    14  ods on and after January first, two thousand seven:];
    15    [(i)] (ii) a report on hospital costs incurred and uncollected amounts
    16  in  providing  services to [eligible] patients [without insurance] found
    17  eligible for financial assistance, including the amount of care provided
    18  for [a nominal payment amount] patients under two hundred percent pover-
    19  ty, during the period covered by the report;
    20    [(ii)] (iii) hospital  costs  incurred  and  uncollected  amounts  for
    21  deductibles  and  coinsurance  for  eligible  patients with insurance or
    22  other third-party payor coverage;
    23    [(iii)] (iv) the number of patients,  organized  according  to  United
    24  States  postal service zip code, race, ethnicity and gender, who applied
    25  for financial assistance [pursuant to] under  the  hospital's  financial
    26  assistance  policy, and the number, organized according to United States
    27  postal service zip code, race, ethnicity and gender, whose  applications
    28  were approved and whose applications were denied;
    29    [(iv)]  (v) the reimbursement received for indigent care from the pool
    30  established [pursuant to] under this section;
    31    [(v)] (vi) the amount of funds that have  been  expended  on  [charity
    32  care]  financial  assistance  from  charitable  bequests  made or trusts
    33  established  for  the  purpose  of  providing  financial  assistance  to
    34  patients  who  are  eligible  in accordance with the terms of [such] the
    35  bequests or trusts;
    36    [(vi)] (vii) for hospitals located in  social  services  districts  in
    37  which  the district allows hospitals to assist patients with such appli-
    38  cations, the number of applications for eligibility for  medicaid  under
    39  title [XIX of the social security act (medicaid)] eleven of article five
    40  of  the  social  services  law  that  the  hospital assisted patients in
    41  completing and the number denied and approved;
    42    [(vii)] (viii) the hospital's financial losses resulting from services
    43  provided under medicaid; and
    44    [(viii)]  (ix)  the  number  of  referrals  to  collection  agents  or
    45  contracted  external collection vendors, court cases and liens placed on
    46  [the primary] any residences of patients through the collection  process
    47  used by a hospital.
    48    (j)  Within  ninety  days  of the effective date of the chapter of the
    49  laws of two thousand twenty-three which amended  this  subdivision  each
    50  hospital  shall submit to the commissioner a written report on its poli-
    51  cies and procedures for financial assistance to patients which are  used
    52  by  the  hospital  [on  the] as of such effective date [of this subdivi-
    53  sion]. Such report shall include copies of its policies and  procedures,
    54  including  material  which is distributed to patients, and a description
    55  of  the  hospital's  financial  aid  policies   and   procedures.   Such
    56  description  shall include the income levels of patients on which eligi-
        A. 6027--A                          9

     1  bility is based, the financial aid eligible  patients  receive  and  the
     2  means of calculating such aid, and the service area, if any, used by the
     3  hospital to determine eligibility.
     4    (k)  The commissioner shall include the data collected under paragraph
     5  (i) of this subdivision in regular audits of the annual general hospital
     6  institutional cost report.
     7    (l) In the event [it is determined by the commissioner that] the state
     8  [will be] is  unable  to  secure  all  necessary  federal  approvals  to
     9  include, as part of the state's approved state plan under title nineteen
    10  of  the  federal  social  security  act, a requirement[, as set forth in
    11  paragraph one of this subdivision,] that compliance with  this  subdivi-
    12  sion  is  a  condition of participation in pool distributions authorized
    13  pursuant to this section and section  twenty-eight  hundred  seven-w  of
    14  this  article, then such condition of participation shall be deemed null
    15  and void [and, notwithstanding]. Notwithstanding section twelve of  this
    16  chapter,  failure to comply with [the provisions of] this subdivision by
    17  a general hospital [on and after the date of such  determination]  shall
    18  make  [such]  the  hospital liable for a civil penalty not to exceed ten
    19  thousand dollars for each [such] violation. The imposition of [such] the
    20  civil penalties shall be subject to [the provisions of] section twelve-a
    21  of this chapter.
    22    (m) A hospital or its  collection  agents  shall  not  report  adverse
    23  information about a patient to a consumer or financial reporting entity.
    24  A  hospital  or  its  collection agent shall not commence a civil action
    25  against a patient or delegate a collection activity to a debt  collector
    26  for  nonpayment for one hundred eighty days after the first post-service
    27  bill is issued and until a  hospital  has  made  reasonable  efforts  to
    28  determine whether a patient qualifies for financial assistance. A hospi-
    29  tal  shall  not  commence a civil action against a patient or delegate a
    30  collection activity to a debt collector, if: the hospital  was  notified
    31  that  an  appeal  or  a review of a health insurance decision is pending
    32  within the immediately preceding sixty days; or the patient has a  pend-
    33  ing application for or qualified for financial assistance.
    34    §  3.  Subdivision  9-a of section 2807-k of the public health law, as
    35  amended by section two of this act, is amended to read as follows:
    36    9-a. (a) (i) As a condition for participation  in  pool  distributions
    37  authorized  pursuant  to  this  section and section twenty-eight hundred
    38  seven-w of this article for periods on  and  after  January  first,  two
    39  thousand  nine,  general  hospitals  shall, effective for periods on and
    40  after January first, two thousand [seven, establish] twenty-five,  adopt
    41  and implement the uniform financial assistance [policies and procedures,
    42  in accordance with the provisions of this subdivision,] form and policy,
    43  to  be developed and issued by the commissioner. General hospitals shall
    44  implement the uniform policy and  form  for  reducing  hospital  charges
    45  otherwise  applicable  to  low-income individuals who can demonstrate an
    46  inability to pay full charges, and also, at the  hospital's  discretion,
    47  for  reducing  or  discounting  the collection of co-pays and deductible
    48  payments from those individuals who can demonstrate an inability to  pay
    49  such  amounts.  Immigration status shall not be an eligibility criterion
    50  for the purpose of determining financial assistance under this  section.
    51  As used in this section, "affiliated provider" means a provider that is:
    52  (A)  employed  by the hospital; (B) under a professional services agree-
    53  ment with the hospital; or (C) a clinical faculty member  of  a  medical
    54  school  or other school that trains individuals to be providers and that
    55  is affiliated with the hospital or health system.
        A. 6027--A                         10

     1    (ii) A general hospital may use the New York state of  health  market-
     2  place  eligibility  determination page to establish the patient's house-
     3  hold income and residency in lieu of  the  financial  application  form,
     4  provided  it  has secured the consent of the patient. A general hospital
     5  shall  not  require a patient to apply for coverage through the New York
     6  state of health marketplace  in  order  to  receive  care  or  financial
     7  assistance.
     8    (iii)  Upon submission of a completed application form, the patient is
     9  not liable for any bills and no interest may accrue  until  the  general
    10  hospital  has  rendered a decision on the application in accordance with
    11  this subdivision.
    12    (b) The reductions from charges for patients  described  in  paragraph
    13  (a)  of  this  subdivision with incomes below six hundred percent of the
    14  federal poverty level shall result in a charge to such individuals  that
    15  does  not  exceed  the  amount  that  would  have been paid for the same
    16  services provided pursuant to title XVIII of the federal social security
    17  act (medicaid), and provided further that such amount shall be  adjusted
    18  according to income level as follows:
    19    (i)  For  patients with incomes at or below two hundred percent of the
    20  federal poverty level, the hospital shall waive all charges. No  nominal
    21  payment shall be collected;
    22    (ii)  For  patients  with  incomes above two hundred percent and up to
    23  four hundred percent of the federal poverty level,  the  hospital  shall
    24  collect  no  more  than  the  amount  identified  after application of a
    25  proportional sliding  fee  schedule  under  which  patients  with  lower
    26  incomes  shall  pay  the lowest amount.  The schedule shall provide that
    27  the amount the hospital may collect for the patient increases  from  the
    28  nominal  amount described in subparagraph (i) of this paragraph in equal
    29  increments as the income of the patient increases, up to  a  maximum  of
    30  twenty  percent  of  the  amount  that would have been paid for the same
    31  services provided pursuant to title XVIII of the federal social security
    32  act (medicaid);
    33    (iii) For patients with incomes above four hundred percent and  up  to
    34  six  hundred  percent  of  the federal poverty level, the hospital shall
    35  collect no more than the amount that would have been paid for  the  same
    36  services provided pursuant to title XVIII of the federal social security
    37  act (medicaid).
    38    (c)  Nothing  in this subdivision shall be construed to limit a hospi-
    39  tal's ability to establish patient eligibility for payment discounts  at
    40  income  levels  higher  than  those  specified  herein and/or to provide
    41  greater payment discounts for eligible patients than those  required  by
    42  this subdivision.
    43    (d)  [Such  policies and procedures shall be clear, understandable, in
    44  writing and publicly available in summary form.] Each  general  hospital
    45  participating  in the pool shall ensure that every patient is made aware
    46  of the existence of [the policies and procedures] the uniform  financial
    47  assistance  form and policy and is provided, in a timely manner, with [a
    48  summary and] a copy of the policy and  form  at  intake,  admission  and
    49  discharge.    [Any  summary  provided  to  patients shall, at a minimum,
    50  include, in plain language, specific information  as  to  income  levels
    51  used to determine eligibility for assistance, financial assitance avail-
    52  able and the means of applying for assistance.] A plain language summary
    53  of the collections process must also be made available. A general hospi-
    54  tal  shall notify patients by providing written materials to patients or
    55  their authorized representatives  during  the  intake  and  registration
    56  process,  by  making materials available in conspicuous locations in the
        A. 6027--A                         11

     1  hospital including emergency departments, waiting areas and other places
     2  patients congregate, through the conspicuous posting of  language-appro-
     3  priate information in the general hospital, and by including information
     4  on  bills and statements sent to patients, that financial assistance may
     5  be available to qualified patients and how to  obtain  further  informa-
     6  tion.    General  hospitals  shall post the uniform financial assistance
     7  application policy[, procedures] and form, and a summary of  the  policy
     8  [and  procedures]  and collection process, in a conspicuous location and
     9  downloadable form on the general hospital's  website.  The  commissioner
    10  shall post the uniform financial assistance form and policy in download-
    11  able  form  on  the  department's hospital profile page or any successor
    12  website.
    13    (e) The [hospital's] commissioner shall provide application  materials
    14  to  general hospitals, including the uniform financial assistance appli-
    15  cation form and policy. These  application  materials  shall  include  a
    16  notice to patients that upon submission of a completed application form,
    17  the patient shall not be liable for any bills until the general hospital
    18  has  rendered  a  decision  on  the  application in accordance with this
    19  subdivision.  The application materials shall include specific  informa-
    20  tion  as  the  income levels used to determine eligibility for financial
    21  assistance[, a description of the primary service area of the  hospital]
    22  and the means to apply for assistance. Nothing in this subdivision shall
    23  be  construed  as precluding the use of presumptive eligibility determi-
    24  nations by hospitals on behalf of patients.  The  [policies  and  proce-
    25  dures]  uniform  application form and policy shall include clear, objec-
    26  tive criteria for  determining  a  patient's  ability  to  pay  and  for
    27  providing  such adjustments to payment requirements as are necessary. In
    28  addition to adjustment mechanisms such  as  sliding  fee  schedules  and
    29  discounts to fixed standards, [such policies and procedures] the uniform
    30  policy  shall  also  provide  for  the  use of installment plans for the
    31  payment of outstanding balances by patients [pursuant to the  provisions
    32  of  the  hospital's  financial  assistance  policy]. The monthly payment
    33  under such a plan shall not exceed five percent  of  the  gross  monthly
    34  income of the patient.  Installment plan payments may not be required to
    35  begin  before  one  hundred eighty days after the date of the service or
    36  discharge, whichever is later. The policy shall allow  the  patient  and
    37  the  hospital  to  mutually  agree to modify the terms of an installment
    38  plan.   The rate of interest  charged  to  the  patient  on  the  unpaid
    39  balance,  if  any,  shall not exceed two percentum per annum and no plan
    40  shall include an accelerator or similar clause under which a higher rate
    41  of interest is triggered upon a  missed  payment.    The  [policies  and
    42  procedures]  uniform policy shall not include a requirement of a deposit
    43  prior to medically-necessary  care.    The  hospital  shall  refund  any
    44  payments made by the patient before the determination of eligibility for
    45  financial   assistance   that  exceeds  the  patient's  liability  after
    46  discounts are applied.  Such policies and procedures  shall  be  applied
    47  consistently to all eligible patients.
    48    (f)  In  any  legal  action by or on behalf of a hospital to collect a
    49  medical debt, the complaint shall be accompanied by an affidavit by  the
    50  hospital's  chief  financial officer stating that the hospital has taken
    51  reasonable steps to determine whether the patient qualifies  for  finan-
    52  cial  assistance  and  upon  information and belief the patient does not
    53  meet the income or residency criteria for financial assistance. Patients
    54  may apply for financial assistance at any  time  during  the  collection
    55  process, including after the commencement of a medical debt court action
    56  or  upon  the  plaintiff  obtaining a default judgment.  A determination
        A. 6027--A                         12

     1  that a patient is eligible for financial assistance shall be valid for a
     2  minimum of twelve months and  will  apply  to  all  outstanding  medical
     3  bills.    A hospital may use credit scoring software for the purposes of
     4  establishing  income eligibility and approving financial assistance, but
     5  only if the hospital makes clear to the patient that providing a  social
     6  security  number  is  not  mandatory and the scoring does not negatively
     7  impact the patient's credit score.   However,  credit  scoring  software
     8  shall  not  be solely relied upon by the hospital in denying a patient's
     9  application for financial assistance. Further, propensity to pay  scores
    10  may  not  disqualify patients who otherwise qualify for eligibility from
    11  receiving financial assistance. Further, propensity to pay scores  shall
    12  not  disqualify  patients  who  otherwise  qualify  for eligibility from
    13  receiving financial assistance. The [policies  and  procedures]  uniform
    14  policy  and  form  policies  and procedures shall allow patients seeking
    15  financial assistance to provide the following financial information  and
    16  documentation in support of their application:  pay checks or pay stubs;
    17  unemployment  documentation;  social  security  income; rent receipts; a
    18  letter from the patient's employer  attesting  to  the  patient's  gross
    19  income;  documentation  of eligibility for other means-tested government
    20  benefits; or, if none of the aforementioned information  and  documenta-
    21  tion  are  available, a written self-attestation of the patient's income
    22  may be used. General hospitals must  take  reasonable  steps  to  assist
    23  patients  in understanding the hospital's application and form, policies
    24  and procedures and in applying  for  payment  adjustments.  [Application
    25  forms  shall be printed and posted] The commissioner shall translate the
    26  uniform financial  assistance  application  form  and  policy  into  the
    27  "primary  languages"  of  each  general  hospital. Each general hospital
    28  shall print and post these materials to  its  website  in  the  "primary
    29  languages"  of patients served by the general hospital. For the purposes
    30  of this paragraph, "primary languages" shall include any  language  that
    31  is  either  (i)  used  to  communicate,  during at least five percent of
    32  patient visits in a year, by patients who cannot speak, read,  write  or
    33  understand  the  English  language at the level of proficiency necessary
    34  for effective communication with health care providers, or  (ii)  spoken
    35  by limited-English speaking individuals comprising more than one percent
    36  of  the  primary  hospital  service area population, as calculated using
    37  demographic information available from the United States Bureau  of  the
    38  Census,  supplemented  by  data from school systems. Decisions regarding
    39  such applications shall be made within  thirty  days  of  receipt  of  a
    40  completed  application.  The [policies and procedures] uniform financial
    41  assistance policy shall require that the hospital issue  any  denial  or
    42  approval  of  the  application in writing which clearly communicates the
    43  amount of assistance granted, any amounts still owed with information on
    44  how to appeal the decision and shall require the hospital  to  establish
    45  an  appeals  process  under which it will evaluate the decision about an
    46  application. Nothing in this subdivision shall prevent a  hospital  from
    47  informing  and assisting a patient with an application for health insur-
    48  ance coverage with a local  services  district  or  the  marketplace.  A
    49  hospital shall not make the availability of financial assistance contin-
    50  gent  upon the patient's application for health insurance coverage.  The
    51  hospital shall inform patients on how to file a  complaint  against  the
    52  hospital  or a debt collector that is contracted on behalf of the hospi-
    53  tal regarding the patient's bill.   General hospitals  are  required  to
    54  take  reasonable  measures  to determine if a patient  is  eligible  for
    55  financial assistance including prior to making a referral  to  a  third-
    56  party debt collector or  other extraordinary collections measures.
        A. 6027--A                         13

     1    (g)  The [policies and procedures] uniform financial assistance policy
     2  shall provide that patients with incomes below six  hundred  percent  of
     3  the  federal  poverty  level are deemed eligible for payment adjustments
     4  and shall conform to the requirements set forth in paragraph (b) of this
     5  subdivision,  provided,  however, that nothing in this subdivision shall
     6  be interpreted as  precluding  hospitals  from  extending  such  payment
     7  adjustments  to  other  patients,  either generally or on a case-by-case
     8  basis.  For patients determined to be eligible for financial  assistance
     9  under the terms of [a hospital's] the uniform financial assistance poli-
    10  cy,  the  [policies  and  procedures]  financial assistance policy shall
    11  prohibit any limitations on financial assistance for services  based  on
    12  the  medical  condition of the applicant, other than typical limitations
    13  or exclusions based on medical necessity or the clinical or  therapeutic
    14  benefit of a procedure or treatment.
    15    (h)  A  hospital  or its agent shall not issue, authorize or permit an
    16  income execution of a patient's wages, secure a lien or force a sale  or
    17  foreclosure  of  a  patient's  primary  residence in order to collect an
    18  outstanding medical bill and shall not send an account to collection  if
    19  the  patient has submitted a completed application for financial assist-
    20  ance, until it has  made  reasonable  efforts  to  determine  whether  a
    21  patient  qualifies for financial assistance or while the hospital deter-
    22  mines the patient's eligibility for financial assistance.  The [policies
    23  and procedures] uniform policy shall provide for  written  notification,
    24  which  shall  include  notification  on a patient bill, to a patient not
    25  less than thirty days prior to the referral of debts for collection  and
    26  shall  require  that the collection agency obtain the hospital's written
    27  consent prior to commencing a legal action.   The [policies  and  proce-
    28  dures]  uniform  policy  shall  require  all  general hospital staff who
    29  interact  with  patients  or  have  responsibility   for   billing   and
    30  collections to be trained in the [policies and procedures] uniform poli-
    31  cy, and require the implementation of a mechanism for the general hospi-
    32  tal to measure its compliance with the [policies and procedures] uniform
    33  policy.  The [policies and procedures] uniform policy shall require that
    34  any  collection  agency,  lawyer  or  firm under contract with a general
    35  hospital for the collection of debts  follow  the  [hospital's]  uniform
    36  financial assistance policy, including providing information to patients
    37  on  how to apply for financial assistance where appropriate.  The [poli-
    38  cies and procedures] uniform policy shall prohibit  collections  from  a
    39  patient  who  is  determined to be eligible for medical assistance under
    40  title eleven of article five of the social  services  law  at  the  time
    41  services were rendered and for which services medicaid payment is avail-
    42  able.
    43    (i) Reports required to be submitted to the department by each general
    44  hospital  as  a  condition for participation in the pools shall contain:
    45  (i) a certification from an independent certified public  accountant  or
    46  independent  licensed  public accountant or an attestation from a senior
    47  official of the hospital that the hospital is in compliance with  condi-
    48  tions of participation in the pools;
    49    (ii)  a  report  on hospital costs incurred and uncollected amounts in
    50  providing services to patients found eligible for financial  assistance,
    51  including  the  amount  of  care provided for patients under two hundred
    52  percent poverty, during the period covered by the report;
    53    (iii) hospital costs incurred and uncollected amounts for  deductibles
    54  and coinsurance for eligible patients with insurance or other third-par-
    55  ty payor coverage;
        A. 6027--A                         14

     1    (iv)  the  number  of  patients,  organized according to United States
     2  postal service zip code, race, ethnicity and  gender,  who  applied  for
     3  financial assistance under the [hospital's] uniform financial assistance
     4  policy,  and  the  number,  organized  according to United States postal
     5  service  zip  code,  race, ethnicity and gender, whose applications were
     6  approved and whose applications were denied;
     7    (v) the reimbursement received for indigent care from the pool  estab-
     8  lished under this section;
     9    (vi)  the amount of funds that have been expended on financial assist-
    10  ance from charitable bequests made or trusts established for the purpose
    11  of providing financial  assistance  to  patients  who  are  eligible  in
    12  accordance with the terms of the bequests or trusts;
    13    (vii)  for hospitals located in social services districts in which the
    14  district allows hospitals to assist patients with such applications, the
    15  number of applications for eligibility for medicaid under  title  eleven
    16  of  article  five  of the social services law that the hospital assisted
    17  patients in completing and the number denied and approved;
    18    (viii)  the  hospital's  financial  losses  resulting  from   services
    19  provided under medicaid; and
    20    (ix)  the  number  of  referrals  to  collection  agents or contracted
    21  external collection vendors, court cases and liens placed on  any  resi-
    22  dences of patients through the collection process used by a hospital.
    23    (j)  [Within  ninety  days of the effective date of the chapter of the
    24  laws of two thousand twenty-three which amended  this  subdivision  each
    25  hospital  shall submit to the commissioner a written report on its poli-
    26  cies and procedures for financial assistance to patients which are  used
    27  by  the  hospital  as  of such effective date. Such report shall include
    28  copies of its policies  and  procedures,  including  material  which  is
    29  distributed  to  patients, and a description of the hospital's financial
    30  aid policies and procedures. Such description shall include  the  income
    31  levels  of  patients  on  which  eligibility is based, the financial aid
    32  eligible patients receive and the means of calculating such aid, and the
    33  service area, if any, used by the hospital to determine eligibility.
    34    (k)] The commissioner shall include the data collected under paragraph
    35  (i) of this subdivision in regular audits of the annual general hospital
    36  institutional cost report.
    37    [(l)] (k) In the event the state is unable  to  secure  all  necessary
    38  federal approvals to include, as part of the state's approved state plan
    39  under  title  nineteen of the federal social security act, a requirement
    40  that compliance with this subdivision is a condition of participation in
    41  pool distributions authorized pursuant to this section and section twen-
    42  ty-eight hundred seven-w of this article, then such condition of partic-
    43  ipation shall be deemed null and void. Notwithstanding section twelve of
    44  this chapter, failure to comply  with  this  subdivision  by  a  general
    45  hospital  shall  make  the  hospital  liable  for a civil penalty not to
    46  exceed ten thousand dollars for each violation. The  imposition  of  the
    47  civil penalties shall be subject to section twelve-a of this chapter.
    48    [(m)] (l) A hospital or its collection agents shall not report adverse
    49  information about a patient to a consumer or financial reporting entity.
    50  A  hospital  or  its  collection  agent  shall not commence civil action
    51  against a patient or delegate a collection activity to a debt  collector
    52  for  nonpayment for one hundred eighty days after the first post-service
    53  bill is issued and until a  hospital  has  made  reasonable  efforts  to
    54  determine whether a patient qualifies for financial assistance. A hospi-
    55  tal  or its collection agent shall not commence a civil action against a
    56  patient or delegate a collection activity to a debt collector,  if:  the
        A. 6027--A                         15

     1  hospital  was  notified that an appeal or a review of a health insurance
     2  decision is pending within the immediately preceding sixty days; or  the
     3  patient has a pending application for or qualified for financial assist-
     4  ance.
     5    §  4.  Subdivision  14  of  section 2807-k of the public health law is
     6  REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions  14,
     7  15 and 16.
     8    §  5.  This  act  shall  take  effect immediately; provided   that (a)
     9  section two of this act shall take effect on the one  hundred  twentieth
    10  day  after  it  shall have become a law; and (b) sections one, one-a and
    11  three of this act shall take effect October 1, 2024 and apply to funding
    12  distributions made on or after January 1, 2025; provided, however,  that
    13  if  subpart C of part Y of chapter 57 of the laws of 2023 shall not have
    14  taken effect on or before such date then section one-a of this act shall
    15  take effect on the same date and in the same manner as such  subpart  of
    16  such  part  of such chapter of the laws of 2023, takes effect. Effective
    17  immediately, the commissioner of health may make  regulations  and  take
    18  other  actions  reasonably  necessary to implement sections one, two and
    19  three of this act on their respective effective dates.